{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:11Z","timestamp":1787018111897,"version":"build-2736575974"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,10,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Approximately 90% of patients presenting to the emergency department with suspected acute coronary syndrome have acute myocardial infarction excluded, but they remain at risk of major adverse cardiovascular events. This study assessed the long\u2010term outcomes of such patients, focusing on the incremental value of multiple biomarkers combined with clinical risk scores for risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this prospective observational study, 487 patients with suspected acute coronary syndrome but excluded acute myocardial infarction were recruited from a large urban hospital, with a median follow\u2010up of 5.8\u2009years. The primary end point was major adverse cardiovascular events, including adjudicated type 1 myocardial infarction, unstable angina requiring urgent revascularization, and cardiovascular death. Biomarkers assessed were hs\u2010cTnT (high\u2010sensitivity cardiac troponin T), hs\u2010cTnI (high\u2010sensitivity cardiac troponin I), HFABP (heart\u2010type fatty acid binding protein), GDF\u201015 (growth differentiation factor 15), NT\u2010proBNP (N\u2010terminal prohormone of brain naturetic peptide), galectin\u20103, and hs\u2010CRP (high\u2010sensitivity C\u2010reactive protein (). Statistical methods included receiver operating characteristic analysis, Kaplan\u2013Meier curves, net reclassification index, and Cox proportional hazards models to evaluate biomarker utility independently and combined with Thrombolysis in Myocardial Infarction and History, ECG, Age, Risk Factors, Troponin scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Of the 487 patients (median age 56 years; 44% female), 9.9% experienced major adverse cardiovascular events. Annualized major adverse cardiovascular events rates for patients with troponin levels below the limit of detection were 0.5% (hs\u2010cTnT) and 0.7% (hs\u2010cTnI), with no cardiovascular deaths over 5\u2009years. Both hs\u2010cTnT and hs\u2010cTnI levels modestly enhanced risk stratification when added to Thrombolysis in Myocardial Infarction or History, ECG, Age, Risk Factors, Troponinscores. Of the non\u2010necrosis biomarkers, only GDF\u201015 demonstrated independent prognostic value in multivariable models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Hs\u2010cTnT, hs\u2010cTnI, and GDF\u201015 improve the long\u2010term risk stratification of the History, ECG, Age, Risk Factors, Troponinand Thrombolysis in Myocardial Infarction scores in patients with suspected acute coronary syndrome and acute myocardial infarction excluded. Hs\u2010cTn of either type at or below limit of detection was associated with excellent short\u2010 and long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03628586.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.040590","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T12:25:40Z","timestamp":1760444740000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Risk Stratification of Acute Chest Pain in Patients With High\u2010Sensitivity Troponin T Below the 99th Percentile: A Long\u2010Term Cohort Study Assessing the Incremental Value of Necrosis and Non\u2010necrosis Biomarkers to Clinical Risk Scores"],"prefix":"10.1161","volume":"14","author":[{"given":"Julia","family":"Jones","sequence":"first","affiliation":[{"name":"Liverpool University Hospitals, NHS Foundation Trust","place":["Liverpool, UK"]},{"name":"Liverpool Heart and Chest Hospital, NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3903-4657","authenticated-orcid":false,"given":"Elen","family":"Hughes","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Dobson","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Ashrafi","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4843-3433","authenticated-orcid":false,"given":"Thomas","family":"Heseltine","sequence":"additional","affiliation":[{"name":"Liverpool University Hospitals, NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Campbell","sequence":"additional","affiliation":[{"name":"Northern Ireland Medical Dental Training Association","place":["Belfast, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7000-5996","authenticated-orcid":false,"given":"Paul","family":"Collinson","sequence":"additional","affiliation":[{"name":"St. George\u2019s University Hospitals, NHS Foundation Trust","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1343-8453","authenticated-orcid":false,"given":"Aleem","family":"Khand","sequence":"additional","affiliation":[{"name":"Liverpool University Hospitals, NHS Foundation Trust","place":["Liverpool, UK"]},{"name":"Liverpool Heart and Chest Hospital, NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.027599"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2048872618755369"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31923-8"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00391-8"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-314093"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015724"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2011.11.022"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007914"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.020"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/2048872616642952"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2024-323913"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-075009"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.1038"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.062"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573403X13666170116121451"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(03)00168-2"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa011053"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.06.026"}],"container-title":["Journal 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